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Larry Puthenparambil, Yu-Guang He; Front or Back?: Intracameral vs. Intravitreal Injection of Bevacizumab for Neovascular Glaucoma. Invest. Ophthalmol. Vis. Sci. 2013;54(15):214.
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Anti-VEGF agents such as Bevacizumab are used for neovascular glaucoma in order to reduce the VEGF burden. Giving this agent into the posterior segment increases the intraocular pressure which leads to an anterior chamber paracentesis. Placing this agent into the anterior chamber has effect on the neovascularization of the iris and angle and has less effect on the intraocular pressure. This study compares the differences in the intraocular pressure and reduction in neovascularization between intracameral bevacizumab (ICB) and intravitreal Bevacizumab (IVB).
This is a retrospective study done at Parkland Memorial Hospital to look at the differences in the vision, pressure and neovascularization changes between IVB and ICB. There were 19 patients total that fit the criteria that were required such as IOP measurement before and after injection. Nine patients received intravitreal injections and ten patients received intracameral injections.
The primary endpoints was looking at intraocular pressure pre and post injection as well as regression of neovascularization. Secondary endpoint was need for anterior chamber paracentesis. The mean intraocular pressure in intracameral Bevacizumab patients was lower than the intravitreal Bevacizumab and it was statistically significant. The number of anterior chamber paracentesis required for the intracameral group was much lower than the intravitreal group.
Intracameral Bevacizumab has been previously shown to reduce neovascularization due to neovascular glaucoma, but no study has compared intravitreal to intracameral bevacizumab. The advantages to doing intracameral injections versus intravitreal injections are two-fold. One is that there is not a sudden increase in intraocular pressure causing discomfort to the patient and placing the optic nerve at further risk of damage. The other advantage is to not have to place a needle into the eye twice, therefore not exposing the eye to excess pathogens. The results show a statistically significant difference in the intraocular pressures before and after injection in the two groups.
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